Indirect vs Direct Hospital Quality Indicators for Very Low-Birth-Weight Infants

CONTEXT Evidence-based selective referral strategies are being used by an increasing number of insurers to ensure that medical care is provided by high-quality providers. In the absence of direct-quality measures based on patient outcomes, the standards currently in place for many conditions rely on...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2004-01, Vol.291 (2), p.202-209
Main Authors: Rogowski, Jeannette A, Horbar, Jeffrey D, Staiger, Douglas O, Kenny, Michael, Carpenter, Joseph, Geppert, Jeffrey
Format: Article
Language:English
Subjects:
Babies
Biological and medical sciences
Birth weight
Clinical outcomes
Diseases of mother, fetus and pregnancy
Female
Gynecology. Andrology. Obstetrics
Hospital Mortality
Humans
Infant Mortality
Infant, Newborn
Infant, Very Low Birth Weight
Intensive Care Units, Neonatal - standards
Intensive Care Units, Neonatal - utilization
Logistic Models
Male
Medical sciences
Outcome Assessment (Health Care)
Patient Admission - statistics & numerical data
Patient admissions
Pregnancy. Fetus. Placenta
Quality Indicators, Health Care
Referrals
Retrospective Studies
Risk Adjustment
Vermont - epidemiology
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Summary:CONTEXT Evidence-based selective referral strategies are being used by an increasing number of insurers to ensure that medical care is provided by high-quality providers. In the absence of direct-quality measures based on patient outcomes, the standards currently in place for many conditions rely on indirect-quality measures such as patient volume. OBJECTIVES To assess the potential usefulness of volume as a quality indicator for very low-birth-weight (VLBW) infants and compare volume with other potential indicators based on readily available hospital characteristics and patient outcomes. DESIGN, SETTING, AND PARTICIPANTS A retrospective study of 94 110 VLBW infants weighing 501 to 1500 g born in 332 Vermont Oxford Network hospitals with neonatal intensive care units between January 1, 1995, and December 31, 2000. MAIN OUTCOME MEASURES Mortality among VLBW infants prior to discharge home; detailed case-mix adjustment was performed by using patient characteristics available immediately after birth. RESULTS In hospitals with less than 50 annual admissions of VLBW infants, an additional 10 admissions were associated with an 11% reduction in mortality (95% confidence interval [CI], 5%-16%; P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.291.2.202